A prospective study of changes in anxiety, depression, and problems in living during chemotherapy treatments: effects of age and gender

PurposeMonitoring distress assessment in cancer patients during the treatment phase is a component of good quality care practice. Yet, there is a dearth of prospective studies examining distress. In an attempt to begin filling this gap and inform clinical practice, we conducted a prospective, longitudinal study examining changes in distress (anxiety, depression, and problems in living) by age and gender and the roles of age and gender in predicting distress.MethodsNewly diagnosed Brazilian cancer patients (N = 548) were assessed at three time points during chemotherapy. Age and gender were identified on the first day of chemotherapy (T1); anxiety, depression, and problems in living were self-reported at T1, the planned midway point (T2), and the last day of chemotherapy (T3).ResultsAt T1, 37 and 17% of patients reported clinically significant levels of anxiety and depression, respectively. At T3, the prevalence was reduced to 4.6% for anxiety and 5.1% for depression (p < .001). Patients 40-55 years, across all time points, reported greater anxiety and practical problems than patients >70 years (p < .03). Female patients reported greater emotional, physical, and family problems than their male counterparts (p < .04).ConclusionsFor most patients, elevated levels of distress noted in the beginning of treatment subsided by the time of treatment completion. However, middle-aged and female patients continued to report heightened distress. Evidence-based psychosocial intervention offered to at risk patients during early phases of the treatment may provide distress relief and improve outcomes over the illness trajectory while preventing psychosocial and physical morbidity due to untreated chronic distress

Second thoughts about implementing routine screening of cancer patients for distress

Recommendations for routine screening of cancer patients for distress lack evidence that screening improves patient outcomes. Settings contemplating screening should consider other options for using the same resources. This article reviews evidence relevant to decision making and calls attention to limits in using screening instruments cross-culturally and for triaging patients for receipt of services. Whether screening is the best option depends on the patient population, culture, and health system

To treat or not to treat: who should decide?

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Lay understanding of common medical terminology in oncology

OBJECTIVE: The purpose of this study was to replicate and extend an earlier study carried out in the UK of lay understanding of cancer-related terms in a Dutch sample, by (i) examining understanding of common terms relating to diagnosis, prognosis, and treatment and (ii) experimentally exploring the effect of medical jargon versus plain language use on individuals' perceived efficacy in interacting with oncologists, participating in medical decision making, and interpersonal trust. METHODS: One hundred ninety-four lay people completed a questionnaire assessing (i) understanding, confidence in understanding, and worry after reading 10 scenarios presenting cancer-related terms and (ii) perceived communication efficacy, decision-making efficacy, and trust following a vignette portraying an oncologist using either jargon or plain language. RESULTS: On average, participants understood a majority (6.8 ± 1.6) of cancer-related terms, yet only 2.2% understood all 10 terms correctly. Compared with incorrect understanding, correct understanding was generally related to higher confidence in understanding and to worry levels that better matched the scenarios. Language complexity did not significantly affect measures of perceived efficacy or trust. Overall confidence in understanding was significantly related to measures of perceived efficacy (p < 0.01). CONCLUSION: Similar to the earlier UK study these results suggest that lay people's understanding of commonly-used terms in oncology is suboptimal. Moreover, confidence in understanding was related to perceived efficacy in participating in the consultation. Oncologists should attempt to correct patient misunderstanding to alleviate unnecessary worry and potentially facilitate patient participation. Copyright © 2012 John Wiley & Sons, Ltd.Analysis and support of clinical decision makin